Could you have glaucoma and not know it?
If you had a condition that could cause you to go blind, you’d think you’d at least be aware of it. Yet half of the 3 million Americans with glaucoma have no clue their sight is at risk, according to the Centers for Disease Control and Prevention.
“Glaucoma can be completely symptomless in the early stages, so many patients don’t realize that they need to be checked for it,” says Jennifer Stone, OD, an optometrist and glaucoma specialist at Levin Eyecare in Baltimore.
But make no mistake: Glaucoma is serious. Behind cataracts, it’s the second-leading cause of blindness in adults 50 and older, according to a recent study in The Lancet. Here’s what you need to know to protect your eyes. (If you need medication for glaucoma, Optum Perks can help you afford it. Download our app to get started.)
What is glaucoma, exactly?
Your eye requires a certain amount of internal fluid to function. Glaucoma generally occurs when your eye fails to maintain a balance between the amount of fluid produced and the amount that drains away. As fluid builds up, so does pressure. And that can cause damage to the nerve in the back of the eye, called the optic nerve, explains Amanda Salter, MD, an ophthalmologist in Berkley, Michigan.
Over time, this damage can result in loss of vision. Usually people first experience fading peripheral vision. Untreated, the loss can creep inward. (If your vision is blurry, that could be a symptom of migraines.)
Who is most susceptible to glaucoma?
Anyone can get glaucoma. This is why regular eye exams are important even if you don’t have any obvious risk factors, stresses Dr. Stone. But certain groups are at higher risk. You’re more likely to get glaucoma if:
- You are over age 60.
- You are African American and over age 40. Black people are up to 8 times more likely to get glaucoma than Caucasians, according to the Centers for Disease Control and Prevention.
- You have diabetes. People with diabetes have twice the risk of glaucoma, according to the CDC. The disease affects circulation, so your optic nerve might not be getting as much blood flow as it needs, says Dr. Salter. The disease can also lead to the growth of new blood vessels in places that make it hard for your eye to drain fluid.
- You’ve had a past eye injury. Severe trauma, such as being hit in the eye, can increase eye pressure.
- Frequent steroid use. According to the American Optometric Association, long-term use of corticosteroids such as prednisone and hydrocortisone appear to increase the risk of glaucoma.
How do you know if you have glaucoma?
The only way to know for sure that you have glaucoma is with a complete eye exam. This is one reason the American Academy of Ophthalmology recommends all adults, even those without risk factors or vision problems, have a baseline comprehensive eye exam at age 40. After that, people with no increased risk should follow the academy’s schedule:
- 40 to 54 years old: every 2 to 4 years
- 55 to 64: every 1 to 3 years
- 65 or older: every 1 to 2 years
Those who do have an increased risk need more frequent screening. Talk to your eye doctor about the right schedule for you. During your eye exam, your doctor will do the following to check for glaucoma:
- Measure your eye pressure: Normal eye pressure is usually considered to be between 10 and 20 millimeters of mercury (mmHg).
- Inspect your eye’s drainage angle: This is the area of your eye that drains aqueous fluid, the clear liquid that keeps your orbs healthy. If it’s blocked, it can cause high eye pressure.
- Examine your optic nerve for damage
- Test your peripheral (side) vision
- Measure the thickness of your cornea
It’s important to remember that just 1 abnormal test result — for example, high eye pressure — doesn’t mean you have glaucoma. “These aren’t all thumbs-up or thumbs-down sort of tests,” says Dr. Stone. “We have to consider all the information together for the big picture.”
How is glaucoma treated?
There’s no way to undo damage already done to the optic nerve, says Dr. Salter. So the goal is to stop progression of the disease. “All the treatments work to lower your eye pressure to keep your disease stable and stop any further damage to the optic nerve,” says Dr. Salter.
Depending on how far along the disease is, your doctor may recommend the following:
- Prescription eyedrops. These are applied daily to lower eye pressure, either by reducing the amount of aqueous fluid your eye makes or improving your drainage angle. Download the Optum Perks mobile app to search for discounts on prescription eyedrops.
- Laser surgery. People with the most common form of glaucoma, called open-angle glaucoma, often undergo trabeculoplasty. With this procedure, your eye doctor applies a laser to your eye’s drainage angle so aqueous fluid can drain better. This is usually done in your eye doctor’s office or at an outpatient medical center.
- Surgery. There are several minimally invasive procedures, says Dr. Salter. But for more severe cases, your eye doctor may recommend trabeculectomy. In this procedure, the doctor creates a tiny flap in the white of your eye for aqueous fluid to drain through. In another version of the procedure, you may receive a tiny drainage tube in your eye.
Once glaucoma has been diagnosed and you’ve begun treatment, you’ll want to schedule check-in doctor appointments every 3 months or so, says Dr. Salter. But the exact timing will vary based on your situation. These appointments are critical to your recovery, so be sure to follow your doctor’s guidance.
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How can glaucoma be prevented?
The best way to catch glaucoma early is to schedule regular eye exams, stresses Dr. Stone. This will allow you and your doctor to take action before the condition can threaten your sight. But there are some lifestyle things you can do as well:
Exercise. Regular aerobic activity can lower eye pressure. Plus, it reduces your chance of developing other risk factors for glaucoma, such as high blood pressure or type 2 diabetes. One study published in the journal Medicine & Science in Sports & Exercise found that people who followed the government’s aerobic activity recommendation (at least 150 minutes at a moderate intensity each week) reduced their risk of glaucoma by 50%.
Keep your goggles handy. Eye injuries can lead to glaucoma, so always wear protective eyewear when you’re working with tools around your house. You should also wear protective eyewear while playing sports. Basketball and water activities, such as pool volleyball, were together responsible for more than 9,000 eye injuries in 2019, according to data from Prevent Blindness. On sunny days, you should also always wear sunglasses with UV protection, says Dr. Salter. They can help prevent eye damage that can worsen a certain type of glaucoma.
Kick the smoking habit. Smoking damages the optic nerve, which can contribute to glaucoma, says Dr. Stone. Find the tools to help you quit at the Optum Store.
Eat your leafy greens. A study published in JAMA Ophthalmology looked at the dietary records of more than 100,000 people 25 or older and found that those who ate the most leafy green vegetables had up to a 30% lower risk of developing glaucoma compared to those who ate the least. One theory is that the nitrates in leafy greens help to maintain optimal blood flow and keep blood pressure low.
Of course, you can do everything right and still get unlucky with glaucoma. So make the necessary lifestyle changes that keep you healthy, but don’t neglect your routine eye exams. Remember: The key is to catch the disease early. Do that and you’ll enjoy healthy vision for the rest of your life.
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Glaucoma is the second-leading cause of blindness: The Lancet (2020). “Causes of blindness and vision impairment in 2020 and trends over 30 years”
Overtreatment of high blood pressure could cause normal-tension glaucoma: The Journal of Ophthalmic & Vision Research (2016). “Update on Normal Tension Glaucoma”
Regular exercise reduces glaucoma risk by 50%: Medicine and Science in Sports and Exercise (2018). “Physical Activity, Cardiorespiratory Fitness, and Incident Glaucoma”
Heavy smoking increases the risk of glaucoma by 70%: Eye (2018). “Cigarette smoking and glaucoma in the United States population”
Eating leafy green vegetables decreases the risk of glaucoma by up to 30%: JAMA Ophthalmology (2016). “Association of Dietary Nitrate Intake With Primary Open-Angle Glaucoma.”
African Americans and glaucoma: Centers for Disease Control and Prevention